Alterations in transcranial sonography among Huntington’s disease patients with psychiatric symptoms

Abstract

Transcranial sonography (TCS) is a diagnostic tool in mood and movement disorders. Alterations within the raphe mesencephalic nucleus in the brain have been reported not only in patients with major depression but in patients with depressive symptoms accompanying several neurodegenerative disorders. The aim of the study was to assess the echogenicity of the nucleus raphe and other basal ganglia in patients with Huntington's disease (HD). TCS was performed in 127 HD patients participating in observational studies (Registry/Enroll-HD) in the Institute of Psychiatry and Neurology (Warsaw, Poland). Raphe hypoechogenicity was found in 78% of HD patients with current symptoms of depression (according to DSM-IV criteria), 57% of patients with a previous history of depression, and 56.8% patients who lacked signs or history of depression. Patients with hypoechogenic raphe reported significantly higher depression as measured on the BDI (15.6 ± 1.7) as compared to patients with normal echogenicity (9.5 ± 1.2), (p = 0.023). The diameter of the third ventricle was negatively correlated with Mini-Mental State Examination (MMSE) (rho − 0.37) and total functional capacity (TFC) scores (rho − 0.26). Hyperechogenic substantia nigra was visualized in 66,4% patients with HD and the degree of hyperechogenicity was correlated with the total motor score (TMS) (rho − 0.38). Changes in echogenicity of the basal ganglia are related to both depressive and motor symptoms among patients with HD.

Echogenicity of Brain Structures in Huntington’s Disease Patients Evaluated by Transcranial Sonography – Magnetic Resonance Fusion Imaging using Virtual Navigator and Digital Image Analysis

“…A total of 12 out of 16 HD patients with decreased BR echogenicity reported current or previous depression symptoms. These results are in agreement with the findings of previous studies in which BR hypoechogenicity was observed in 49-67 % of HD patients [15]. In the study by Krogias et al, 72 % and 63 % of patients exhibiting BR hypoechogenicity had current symptoms of depression and a history of depressive episodes, respectively, whereas all patients without a history of depressive episodes showed normal BR echogenicity.…”

“…In addition, SN hyperechogenicity was correlated with bradykinesia subscore in UHDRS, thereby suggesting that the changes in SN echogenicity may be a marker of bradykinetic and rigid motor phenotype of HD [14]. In a recent study, a higher hyperechogenicity of the SN was visualized in 66 % of HD patients, and was correlated with the general motor status measured by UHDRS-TMS [15]. These variations in the percentages of SN hyperechogenicity in these studies might be attributed to different motor phenotypes of HD.…”

“…The low cost and noninvasiveness of TCS allow the use of this technique for serial examinations during the disease course [10]. However, to date, only a few studies have evaluated the changes in the echogenicity of basal ganglia and brainstem structures in HD patients using qualitative (presence of pathology assessed as Yes/No) or semi-quantitative brain structure assessment, which is limited by the dependence on the image quality of the bone window and experience of the sonographer [11,12,13,14,15].…”